The Changing Face of Risk

With the largest celebration of LGBT communities in London taking place on Saturday 27th June as part of International Pride week, and the decision of the US Supreme Court to make legalising Gay marriage part of the national constitution, this week has unquestionably marked a turning point for LGBT equality within social, legal and political culture. And with Caitlyn Jenner’s bold and admirable Vanity Fair cover, LGBT equality and identities are certainly on the media agenda. Here, Amelia Worley expands on the deconstruction of stigma which seems to be occurring in some of the world.

Looking at a history of LGBT identities in the UK and USA, the discrimination experienced by Gay and Bisexual males gained momentum in the 1980s with the outbreak of the HIV epidemics, when these groups were labelled as high risk to the deathly virus and often given as outcasts. These epidemics and the connotations for those affected have been heavily documented in popular culture given the nature of the patterns in which the virus spread, and those who were at high risk of contracting the virus when it first emerged (Gay men and drug users) – think Trainspotting and Philadelphia.

A less glamourous and less popularised element of the history of Pride in the UK and USA is therefore is the development of and access to HIV/AIDs drugs. Last year, the Dallas Buyers Club brought into the limelight the struggles and controversies within the underground movements taking place across the world to improve access to these medicines.

In what would have seemed impossible 30 years ago, thanks to education, awareness and scientific progress, for individuals living in the developed world, HIV/AIDs is now a ‘life-altering’ rather than a life-limiting disease – the patterns of transmission now very different to those 30 years ago. Although HIV epidemics in the developed world are now considered a thing of the past, there are still around 2,500 new diagnoses every year in the UK.

At this year’s Pride event in London, the Terrence Higgins Trust used the event as an opportunity to regain momentum around access to effective HIV medication, and place pressure on the NHS to make pre-exposure prophylaxis (PrEP) freely available. PrEP is taken as a preventative rather than a cure for HIV. The drug is being so supported as research has shown that the drug could be a highly effective preventative – and could protect up to 86% of people from contracting the virus. The Terrence Higgins Trust argue that the PrEP solution could be the end of HIV – and is by far more cost effective for the NHS; PrEP costs around £400 a month, compared to a cost of £350,000 per person for lifetime treatment.

Perhaps with the changing ‘risk’ status of the HIV virus has come an attitudinal shift towards safe sex and using contraception which also prevents STDs (not the contraceptive pill). New research from The Rhode Island Department of Health has shown a distinct rise in STD transmission rates (including a 33% growth in HIV) since the increase in popularity of ‘hook-up’ apps such as Tinder and Grinder – reflecting the increase in high-risk behaviour orchestrated by the apps, with the anonymity of the apps making it harder to track and prevent the spread of viruses. This research adds more weight to the need for health institutions to catch up in terms of what it can offer in terms of solutions.

Unquestionably, the stigma surrounding HIV/AIDs has greatly reduced with the increase in knowledge and education of the virus, and the development of effective treatment. Last week a video went viral which showed people’s reactions to a HIV positive man asking for physical contact, and showed an overwhelming sense of support, but it would be a bit too optimistic (and inaccurate) to claim that this stigma has disappeared altogether.

The cultural and political progression of Gay rights this week has been landmarked all over the world; we now wait for healthcare institutions to go beyond what is necessary to offer treatments to those affected. The situation of access to treatment, given the wider context of access to healthcare in the USA is far more complex, yet the most important shift we are to see will be in the developing world.

In 2013, 1.1 million people died from AIDS-related causes in Sub-Saharan Africa – an astonishing number for a virus which is preventable, and can be treated. Perhaps the establishment of PrEP in the UK as successful and cost-effective solution for HIV is perhaps the precedent which is necessary for HIV drugs to be placed firmly back on the international agenda, and be put into use in areas where the HIV virus still remains prevalent, and a death sentence.

The views expressed in this article are those of the author and do not necessarily represent the views of Development in Action.